Virtual DRCHSD SummitReducing Barriers
to Address Inequities in Healthcare
Dr. Antomia Farrell
She/Her/Hers
Assistant Dean and Director for Diversity
&
National MANRRS President
August 30, 2020
An Equal Opportunity University
Objective
• Outline differences in access to health care by race and ethnicity• Provide examples for reducing barriers for individuals• Discuss how to address equity, diversity and inclusion in the work that
we do, particularly around community engagement• Identify resources, opportunities and education for rural health care
workers and others to address the unique needs of their populations• Provide an on-the-ground perspective of how to address access
barriers from a DRCHSD hospital and clinic.
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The Guidelines
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“Inclusion is a JOURNEY, a PROCESS, and not a DESTINATION”
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Diverse Identities
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• Gender Identity• Sexual Orientation • Religion• Health • Age And MANY MORE!!• Race • Ethnicity• Gender • Socioeconomic Status• Different Abilities • Party affiliation • Migratory status
Listen to Learn and UNDERSTAND
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Guide to Understanding
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Nationality: involves the country in which one holds citizenship. Race: is a social construct, but typically involves a person's self-identification with one or more social groups.
According to the US Census, a person can report as:• White• Black or African American• Asian• American Indian• Alaska Native• Native Hawaiian• Pacific Islander• Other
https://www.census.gov/topics/population/race/about.html
• Ethnicity: involves country or region one is from and also a shared culture, religion, language or association. When we discuss ethnicity, that is where the term Latin X comes into play. There are also Non BlackHispanics and Black Hispanics, based on the color of one's skin.
• BIPOC: Black, indigenous, and People of Color.
Guide to Understanding, continued
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Diversity: The collective mixture of differences and similarities that includes individual and organizational characteristics, values, beliefs, experiences, backgrounds, and behaviors. It encompasses our personal and professional histories that frame how we see the world, collaborate with colleagues and stakeholders, and serve communities
Inclusion: Creation of a space where each person is authentically valued, respected, and supported
“Making the Mix Work”
The Mix
Equity: Providing all people with fair opportunities to attain their full potential to the extent possible
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Equality vs Equity
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ExerciseAs you look at each slide, note the feelings,
judgments and reactions that emerge.
•High/Low Warmth•High/Low Competence
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Judgement
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John Fetterman• Mayor of Braddock, PA (a suburb of Pittsburgh) – the tattoo on his arm is the zip code!• Has a Master’s degree in Public Policy from Harvard• Served in the Americorps• Received international media attention for the economic revitalization programming he
started in his community
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• Economist, attorney• First female President
of India 2007-2012
Pratibah Patil
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•Ted BundyAmerican serial killer and rapist.Confessed to killing 30 women
•
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•Mae JemisonPhysicianProfessor U.S. Astronaut
••
HeightSexual
OrientationAppearance
WeightAccent
Skin Tone
Race
Gender
Name
Religion
Different abilities
What patterns did you notice?
Age
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Types of Unconscious Bias, but not limited to:
Diversity Through Your Lens
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Race,Gender,Age, PhysicalAbility, Behavior
Dress Food, clothing
FamilyEthicsHistory
Knowledge
Experiences
Biases
Assumptions
Prejudices
Family
Beliefs
Traditions
The look: A story about bias in America
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https://youtu.be/aC7lbdD1hq0
Racial Equity
Racial Equity is about applying justice and a little bit of common sense to a system that been out of balance. When a system is out of balance, people of color feel the impacts most acutely, but, to be clear, an imbalanced system makes all of us pay. Center for Social Inclusion President
Glenn Harris
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Imagine Two Neighborhoods
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Neighborhood 1• Stagnated with abandon
homes• Poor schools• Over-policing• Most are people of color
Neighborhood 2
• Plenty of fresh food markets
• Robust bus system• Health centers• “Good” schools• Economic opportunity• Most residents are White
Privilege
• A special right, advantage, or immunity granted or available only to a particular person or group
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Privilege, continued• I have never been denied a position because of my gender• I work in a salary position • I have health insurance• I don’t rely on public transportation • I have never felt poor • I went to summer camp and my parents paid for me to attend • I grew up with both parents in the household• I do not have any physical disabilities • I have never been followed around a store because of my race• I have never felt unsafe because of my gender
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Threat: Race and Racism
People of Color – experience trauma from (or fear of):• Denial of educational, social, employment, and economic opportunities
and being ostracized• Being falsely accused of malice and criminality because of race ~
Emmett Till Syndrome• Being mistreated, physically assaulted, or killed by police or neighbors• Explicit and implicit racist comments• Being view as “less than”• Being labeled an “Angry Person of Color”• One’s children and grandchildren facing the same traumas and
injustices
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Threat: Race and Racism, continued
Whites experience fear of (or trauma from):• Saying or doing the wrong thing• Being accused of being a racist; false binary (Racist=Bad / Not
Racist=Good)• Talking openly about racism (social taboos; white solidarity) • Being held responsible for historical and contemporary existence of
racist systems and structures• Losing present political, economic, education, legal, and social power • Prospect of becoming the minority and facing retribution from
oppressed
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Vulnerability
“Vulnerability is not weakness, and the uncertainty, risk and emotional exposure we face everyday are not optional. Our willingness to own and engage with our vulnerability determines the depth of our courage and the clarity of our purpose; the level to which we protect ourselves from being vulnerable is a measure of our fear and disconnection.”
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Shame
• Shame is the fear of disconnection.• Shame is a full-contact, full-body emotion. • Shame is the intensely painful feeling or experience of believing
that we are flawed and therefore unworthy of love and belonging.
• Shame diminishes our capacity to practice empathy• Silence breeds shame, secrecy and judgement. Interestingly, the
more we talk about shame, the less we have it.
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B. Brown, I thought it was just me…
Guilt
• Guilt is adaptive and helpful – it’s holding something we’ve done or failed to do up against our values and feeling psychological discomfort.
• It can support cognitive dissonance – a important catalyst to support change.
• It opens up the opportunity to ask for or experience grace and forgiveness if we sincerely acknowledge the feeling
• It can become corrosive if it is internalized and it becomes self pity, self absorption or not connected to appropriate action
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B. Brown, I thought it was just me…
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Quote“Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue.”– Sir Michael Marmot
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TestimonialMy name is…(a common Hispanic surname) and when they see that name, I think there is some kind of prejudice [against] the name…we’re talking on the phone, there’s a lack of respect. There’s a lack of acknowledging the person and making one feel welcome. All of the courtesies that go with the profession that they are paid to do are kind of put aside. They think they can get away with a lot because ‘Here’s another dumb Mexican.” (Latinx patient)
Source: Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press, 2003.
Definition for Health Disparity
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“A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”-Healthy People 2020
Culture of Health Definition
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It is one in what all people have an opportunity to live their healthiest lives and where structural, systemic, and interpersonal barriers to health equity are removed.
Social Determinants of Health
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Source: Zinzi Bailey, Health Equity and Structural Racism, RWJF Interdisciplinary Research Leaders Program, 12/6/2019.
Social Determinants of Health, continued
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Source: https://edhub.ama-assn.org/steps-forward/
Social Determinants of Health Across Race
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COVID-19 Health Outcomes
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Recommendations
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• Increase awareness of racial and ethnic disparities in healthcare among the general public and key stakeholders
• Increase healthcare providers’ awareness of disparities• Reduce bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers
may contribute to racial and ethnic disparities in health care• Strengthen the stability of patient-provider relationships in publicly funded plans• Increase the proportion of underrepresented US racial and ethnic minorities among health
professionals. • Support the use of community health workers• Collect and report data on healthcare access and utilization by patient’s race, ethnicity,
socioeconomic status, and primary language• Include measures of racial and ethnic disparities in performance measurement• Monitor progress toward the elimination of healthcare disparities• Adoption of policies and procedures that promote equitable access to primary care services
Source: Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press, 2003.
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Additional Resources
Team Based Approach Recommendation
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1. Ask patients about their SDOH.2. Identify resources in patients’ communities that can help address
SDOH.3. Act to help connect patients with resources to help address
patients’ SDOH.
Ally Willing to act with and for others in pursuit of ending oppression and creating equality and someone whose personal commitment to fighting oppression and prejudice is reflected in willingness to:
1. Educate oneself about different identities and experiences2. Challenge one’s own discomfort and prejudices3. Learn and practice the skills of being an ally while leveraging
your privilege4. Take action to create interpersonal, societal, and institutional
change
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https://opseu.org/
Reflection
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Identify the barriers that individuals in your state face by social determinants of health? Does this vary by race, ethnicity, age, disability, economic security? Are these barriers different for different populations?Identify resources, education and opportunities that you would need to support the healthcare system recognizing the barriers that affect the social determinants of health inequities and the culture of health.
Examples: programs in different languages, extending hours of care, recruiting students to create a pipeline of workers that represent the population, offering trainings on equity, inclusion and diversity, and unconscious bias.
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“I have come to believe over and over again that what is most important to me must be spoken, made verbal and shared, even at the risk of having it bruised or misunderstood.”
- Audre Lorde
Final quote
